POS0972 MOST DISEASE OUTCOME MEASURES BUT NOT ASDAS ARE INFLUENCED BY GENDER IN PATIENTS WITH AXIAL SpA: RESULTS FROM ASAS-PerSpA
Authors: D. Benavent, D. Capelusnik, S. Ramiro, A. Moltó, C. López-Medina, M. Dougados, V. Navarro-Compán
Journal: Annals of the Rheumatic Diseases (2022)

Background There is growing evidence revealing that females report worse patient-reported outcomes compared to males in axial spondyloarthritis (axSpA). However, in which precise outcomes there is a meaningful difference across gender and whether this also occurs in patients with peripheral spondyloarthritis (pSpA) and psoriatic arthritis (PsA) is not fully understood. Objectives To investigate the influence of gender on disease outcomes in patients with SpA, including axSpA, pSpA and PsA, in a worldwide setting. Methods Data from 4185 patients with axSpA, pSpA or PsA from the ASAS-PerSpA study were analysed. The ASAS-PerSpA is a cross-sectional study that recruited consecutive patients with SpA (according to their rheumatologist) from 24 countries. Associations between gender and disease activity [Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Disease Activity Score (BASDAI), C-reactive protein (CRP)], function [Bath Ankylosing Spondylitis Functional Index (BASFI)], and overall health [ASAS-Health Index (ASAS HI), European Quality of Life Five Dimension (EQ-5D)] were investigated. Multilevel (country) univariable and multivariable linear mixed models were used. Interactions between gender and disease phenotype (SpA, pSpA and PsA) were analysed, and if relevant, models were stratified by disease subtype. Models were adjusted for relevant confounders (Table 1). Table 1. Multivariable multilevel model by disease phenotype Outcome Determinant of interest Disease phenotype AxSpA pSpA PsA ASDAS + Gender (female vs male) 0.02 (-0.07, 0.11) 0.36 (0.15, 0.58 ) 0.25 (0.12, 0.38 ) BASDAI * 0.39 (0.20, 0.58 ) 1.22 (0.77, 1.69 ) 0.88 (0.59, 1.16 ) BASFI - 0.01 (-0.14, 0.17) 0.30 (-0.12, 0.71) 0.46 (0.20, 0.72 ) CRP^ -1.36 (-3.17, 0.44) ASAS-HI # 0.90 (0.70, 1.10 ) EQ-5D° -0.02(-0.03, -0.01 ) All models are adjusted by age, gender and education. + Also adjusted for marital status, BMI, smoking, axial involvement, peripheral arthritis, enthesitis, fibromyalgia, NSAIDs, steroids, csDMARDs, bDMARDs * Also adjusted for marital status, BMI, smoking, axial involvement, peripheral arthritis, enthesitis, psoriasis, fibromyalgia, NSAIDs, bDMARDs - Also adjusted for marital status, BMI, ASDAS, radiographic damage, fibromyalgia, NSAIDs, bDMARDs ^ Also adjusted for marital status, BMI, radiographic damage, concomitant NSAIDs, steroids, csDMARDs # Also adjusted for smoking, ASDAS, BASFI, peripheral arthritis, enthesitis, fibromyalgia ° Also adjusted for BMI, smoking, ASDAS, BASFI, radiographic damage, HLA-B27, enthesitis, fibromyalgia Results are expressed in β (95% CI). Estimates with p&lt;0.05 are highlighted in bold Results In total, 4185 patients were included, of which 2719, 1033 and 433 had a diagnosis of axSpA (mean age 42 years, 32% female), PsA (mean age 52 years, 52% female) and pSpA (mean age 44 years, 53% female), respectively. A significant interaction between gender and disease phenotype was found for ASDAS, BASDAI and BASFI. Multivariable models for each outcome are shown in Table 1 (stratified by disease phenotype). While being female independently contributed to higher BASDAI across the three disease phenotypes (though with varying magnitude), female gender was only associated with higher ASDAS in pSpA [β (95% CI): 0.36 (0.15, 0.58)] and PsA [0.25 (0.12, 0.38)] but not in axSpA [0.016 (-0.07, 0.11)]. Female gender was associated with higher BASFI in PsA [0.46 (0.20, 0.72)]. No associations were observed between gender and CRP levels. Female gender was associated with higher ASAS-HI [0.90 (0.70, 1.10)] and EQ5D [-0.02 (-0.03, -0.01)], without significant differences across disease phenotype. Conclusion Female gender was associated with less favorable outcomes across the SpA spectrum, except for CRP in which there were no differences between gender. While female gender influenced BASDAI across disease phenotypes, ASDAS was not associated with gender in axSpA. These results suggests that ASDAS should be the preferred instrument in clinical practice both for females and males with axSpA. Acknowledgements We would like to thank all ASAS-perSpA investigators and members of the scientific committee. Disclosure of Interests Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB, Anna Moltó Consultant of: Abbvie, UCB, Novartis, Gilead, Pfizer, Lilly y Janssen, Grant/research support from: UCB, Clementina López-Medina Speakers bureau: Lilly, Novartis, Janssen, UCB and Abbvie, Maxime Dougados: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie and Novartis